MEDICARE: DOROTHY IJEANETTE TRAIN MCD, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA12892	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477891307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOROTHY IJEANETTE TRAIN MCD, CCC-SLP

Provider Business Mailing Address
First Line	:	12877 DAYBREAK CT E
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-7095
Country	:	US
Telephone Number	:	904-755-1418
Fax Number	:

Provider Business Practice Location Address
First Line	:	12877 DAYBREAK CT E
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-7095
Country	:	US
Telephone Number	:	904-755-1418
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2013
Last Update Date	:	03/11/2021

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